What to do when you have knee pain but your doctor says nothing is wrong

What to do when you have knee pain but your doctor says nothing is wrong

Knee pain is a common problem that can affect people of all ages. It can be caused by a variety of factors, including injury, overuse, and arthritis. In some cases, people may experience knee pain even when their doctor says nothing is wrong.

A doctor will typically diagnose knee pain by taking a medical history, performing a physical exam and ordering imaging tests.  Sometimes, a doctor is unable to diagnose the cause of knee pain based on history, physical exam and imaging. There are a number of potential causes of knee pain that may not be immediately apparent, such as:

  • Patellofemoral pain syndrome: a condition that affects the kneecap and is characterized by pain in front of the knee. It is often caused by overuse or misalignment of the kneecap.
  • Iliotibial band syndrome: a condition that affects the band of tissue that runs along the outside of the thigh. It is characterized by pain on the outside of the knee, especially when walking or running.
  • Meniscus tear: the meniscus is a piece of cartilage that acts as a cushion between the bones of the knee. A tear in the meniscus can cause pain, swelling, and stiffness in the knee.
  • Arthritis: a condition that causes inflammation of the joints. It can affect any joint in the body, including the knee. Arthritis can cause pain, stiffness, and swelling in the knee.
  • Fibromyalgia: fibromyalgia is a chronic pain disorder that affects the muscles and soft tissues throughout the body. It can cause pain in the knees, as well as other symptoms such as fatigue, sleep problems, and difficulty concentrating.

If you are experiencing knee pain, and you haven’t had a thorough workup, it is important to see a doctor to rule out any serious underlying medical conditions. Once any underlying medical conditions have been ruled out, and you are still experiencing pain, it is time to dig a bit deeper.  

In my experience, pain that is not due to an underlying medical condition is often due to an entrapped peripheral nerve.

There are several peripheral nerves that weave in, out and around the muscle, fascia and bones of the knee.  The main nerves are the anterior femoral nerve on the lower thigh and knee cap, the fibular nerve on the lateral side, the obturator and saphenous nerves on the inner side, and the tibial and sural nerves on the back side of the knee.  The location of the pain will show which nerve is entrapped.  For instance, if one is experiencing pain around their knee cap, the anterior femoral nerve is most likely entrapped.  

A peripheral nerve can become entrapped after an acute injury that does not properly heal or due to held tension patterns in the myofascial system.  When a peripheral nerve is entrapped, the resulting pressure reduces the amount of blood flow to the nerve.  A lack of blood flow to the nerve leads to a decrease in glucose, energy, to the nerve and causes the receptor to send a pain signal to the brain.  

While there are a number of things you can do to manage your knee pain, I have found a combination of perineural injection therapy, physical therapy and appropriate movement (avoiding high impact activities such as running and jumping during the healing phase) are great at reducing knee pain without an underlying medical condition.

If you are experiencing knee pain, it is important to talk with a qualified health practitioner about the best course of treatment for you. There are a number of things you can do to manage your pain and improve your function, even if your doctor says nothing is wrong. 


  • Donald Spears

    Dr. Donald Spears is a naturopathic doctor and Chinese medicine practitioner in Boulder, Colorado. He is the Clinic Director of Whole Systems Healthcare Boulder Clinic.

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